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PROOF OF INSURANCE (2018) CLOSED DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1 5/1/2017
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 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).
CONTACT
PRODUCER I NAME: Sandy Peters
Dealey, Renton &Associates IPHONE 626 844-3070 FAX
199 S Los Robles#540 +! (A/c."°':
Pasadena, CA 91101 ADDRESS:-peters @dealeyrenton.com
License#0020739 I INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Westchester Surplus Lines Insurance 10172
INSURED GALEJORDA INSURER B:
Gale/Jordan Associates, Inc. I INSURERC:
3858 Carson Street, Suite 200
Torrance, CA 90503-5613 I INSURER D:
310-316-4377 I INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1757116543 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/YYYY) (MM/DD/YYYY)
• X COMMERCIAL GENERAL LIABILITY Y Y G24391656005 4/28/2017 4/28/2018 EACH OCCURRENCE $3,000,000
XI OCCUR PREMISES ETORENTED
CLAIMS-MADE
PREMISES(Ea occurrence) $50,000
X Contractual Liab MED EXP(Any one person) $5,000
X XCU Included PERSONAL&ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000
POLICY [::] PRO JECT [::] LOC PRODUCTS-COMP/OP AGG $4,000,000
X OTHER: Contractors Poll Contr.Poll.Liab. $3,000,000
• AUTOMOBILE LIABILITY Y 624391656005 4/28/2017 4/28/2018 COMBINED SINGLE LIMIT $2 000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION STATUTE OERH
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Professional Liability G24391656005 4/28/2017 4/28/2018 $3,000,000 Per Claim
$3,000,000 Annual Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
RE:All Operations--City of El Segundo, its officers, agents and employees are named as additional insured as respects general and
hired/non-owned auto liability for claims arising from the operations of the named insured as required per written contract or agreement.
CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation
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
S"EPRE NTATIVE
©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 & NIONI-CONITRIBUTORY
Narned Insured Endorsernent Number
Galle/Jordan Associates Inc
Policy Symbod Policy Number Policy Period Effective Date of Endorsernent
ECP G24391656 005 04/28/2017 to 04/28/2018 04/28/2017
Issued By(Narne of Insurance Company)
Westchester SurpIlus Lines Insurance Company
THIS ENDORSEMENT CH�ANIGES 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 or organization that is an owner of reap 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 compllete this endorsement wflH be shown in the Declarations as
appficaUe to this endorsement.)
Section II —Who Is An Insured is amended to include as an additionall insured the person(s) or organization(s) shown in
the SchedUe, but orally with respect to Iliabillity for bodlily injury or property damage caused, in wh6le or in part, by your
work performed for that additional insured and included in the products-completecl operations hazardl.
Furthermore, the coverage provided hereunder shall)) be primary and not contributing with any other insurance availaUe to
those designated above under any other third party Iliabillity p6licy.
,41 other terms and conditions remain the same.
ENV-3226 (10-08) Page 1 of 1
-K ar ne d-I n sur e d 9"r aorsernent Number
Galle/Jlordan Associates Inc
Policy Symbod policy Number icy Period Effective Date of Endorsernent
ECP G24391656 005 04/28/2017 to 04/28/2018 04/28/2017
ssued By(Narne of insurance Cornpany)
Westchester Surpllus Lines Insurance Company
Insert the policy number- The remainder of the information is to be completed only when this endorsement is issued subsequentto the preparation of the policy-
THlIS ENDORSEMENT CH�ANIGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT-OWNERS, LESSEES OR CONTRACTORS
(PRIMARY AND NIONl-CONITRIBUTORY)
This endorsement modifies insurance provided under the f6lHowing:
COMMERCIAL GENERAL LIABILITY COVERAGE
CONTRACTOR'S POLLUTION LIABILITY COVERAGE
SCHEDULE:
Name of Person or Oraanization:
Any person or organization that is an owner of reap property or personal) property on which you are performing
operations, or a contractor on whose behalf you are performing operations, and orally 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 compllete this endorsement wflH be shown in the Declarations as
appficaUe to this endorsement.)
SECTION II -WH�O IS ANI INSURED is amended to include:
A. SECTION II - WH�O IS ANI INSURED is amended to include as an insured the person or organization shown in the
SchedUe, but orally with respect to Iliabilfity arising out of your ongoing operations performed for that insured.
B. With respect to the insurance afforded to these additional insureds, the f6lHowing exclusion is added:
2. Exclusions
This insurance does not applly to bodily injury or property dlamage occurring after:
(1) AH work, including mateh4ls, parts or equipment furnished in connection with such work, on the project (other
than service, maintenance or repairs) to be performed by or on behaff of the additionall insured(s) at the site of
the covered operations has been complleted; or
(2) 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
priincipal as a part of the same project.
C. The coverage provided hereunder shall)) be primary and not contributing with any other insurance avaflaUe to those
designated above under any other third party Iliabilfity poficy.
IENV-3101 (08-04) Includes copyrighted material of Insurance Services Office, IInc.with its permission IPage 1 of 1
fNarmed insured 0 rrdorsermerrt INurnber
Galle/Jordan ,associates Inc
Policy Syrmbod policy Number policy period Effective Date of Endorserment
ECP G24391656 005 04/28/2017 to 04/28/2018 04/28/2017
Issued By(fNarme of insurance Lormpany)
Westchester Surpllus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsemient is issued subsequent to the preparation of the policy.
THVIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
This endorsement modifies 'insurance provided udder the folllow'ing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS POLLUTION) LIABILITY COVERAGE PART
SCHEDULE
Name of Person or organization:
Any person or organ'izat'ion that is an owner of reap property or personal) property on which you are performing
operations, or a contractor on whose behalf you are performing operations, and orally at the specific written request of
such person or organ'izat'ion to you,wherein such request is made prior to commencement of operations.
(Ilf 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 add'it'ion of the
following:
We waive any right of recovery we may have against the person or organ'izat'ion shown in the Schedulle 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 organ'izat'ion and 'included in the products-completed! operations (hazard). This waiver appll'ies orally to the
person or organ'izat'ion shown in the Schedulle above.
XI other terms and cond'it'ions remain the same.
ENV-3143(03-05) Includes copyrighted material of Insurance Services office, Inc.with its permission Page 1 of 1
fNarmed Insured rrdersermerra INurm6er
Galle/Jordan Associates Inc
Podicy Syrmbod Podicy Number Podicy Periad e=ffective Date of Endersermerra
ECP G24391656 005 04/28/2017 to 04/28/2018 04/28/2017
Issued By(fNarme of Insurance Company)
Westchester aurpllus Lines Insurance Company
THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WIRED AND NIONI-OWNIEIC AUTO LIABILITY COVERAGE ENDORSEMENT
This endorsement modifies insurance provided udder the follllow'ung:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Limits of Insurance: $2,000,000 Each Occurrence
$2,000,000 Aggregate Limit (included in the General)Aggregate)
With respect to the insurance provided by this endorsement, the folllow'ung is added to Section I - COVERAGES:
A. WIRED AUTO LIABILITY
The insurance provided udder this Coverage Part appllues to bodlily injury or property damage arising out of the
maintenance or use of a hired l auto by you or your emplloyee in the course of your business.
B. NIONI-OWNIEIC AUTO LIABILITY
The insurance provided udder this Coverage Part appllues to trodlily injury or property damage arising out of the use
of a non-owned! auto in your business.
With respect to the insurance provided by this endorsement:
A. The COMMERCIAL GENERAL LIABILITY COVERAGE FORM, SECTION I I - COVERAGES, COVERAGE A.
BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2., Exclusions, Items c.., e.., g.., Ih., i., A., Ik., m.., n. and o.
are delleted in their entirety.
B. The folllow'ung additional exclusions are added:
1. Emplloyee Indemnification and Emplloyer's Luab'ulluty
Bodily Injury:
1. To an emplloyee of the insured arising out of and in the course of emplloyment by the insured; or
2. To the spouse, chulld, parent, brother or sister of that emplloyee as a consequence of 1. above.
This exclusion appllues:
1. Whether the insured may be Iliable as an emplloyer or in any other capacity; and
2. To any obllugat'uon to share damages with or repay someone ellse who must pay damages because of
unj a ry.
This exclusion does not applly to:
1. Iiabulfuty assumed by the insured under an insured l contract; or
ENV-7110(02-015) Page 1 of 3
2. Bodlily injury arising out of and in the course of domestic employment by the insured u6less benefits for such
injury are in wh6le or in part either payable or required to be provided under any workers compensation (law.
2. Care, Custody or Contr6l
Property Damage:
1. To property owned or transported by, or rented or Moaned to the insured; or
2. Property in the care, custody or contr6l of the insured.
3. 1`61How Emplloyee
Bodlily injury to any f6lHow employee of the insured arising out of and in the course of the f6lHow employee's
emplloyment or while performing duties r6lated to the conduct of your business.
With respect to the insurance provided by this endorsement the COMMERCIAL GENERAL LIABILITY COVERAGE
FORM, SECTION II -WH�O IS ANI INSURED is d6leted in its entirety and repllaced by the following:
1. Each of the f6lHowing is an insured under this insurance to the extent set forth b6low:
a. You;
b. Anyone 61se whHe using with your permission a non-awned auto or Ihiredl auto except:
1. The owner or anyone 61se from whom you hire or borrow a non-awned auto or Ihiredl auto.
2. Your employee if the non-owned auto is owned by that employee or a member of his or her househ6ld.
3. A partner(if you are a partnership), or a member(if you are a (limited Viability company)for a non-owned auto
owned by him or her or a member of his or her househ6ld.
4. Any person whHe emplloyed in or otherwise engaged in duties in connection with an auto business,other
than an auto business you own or operate.
c. Any other person or organization, but orally with respect to their Iliiabillity because of acts or omissions of an insured
under a., b. or c. above.
With respect to the insurance provided by this endorsement, SECTION III - LIMITS OF INSURANCE, Items 1. and 2. are
d6leted in their entirety and repllaced by the following:
1. Regardlless of the number of Ihiredl autos or non-owned autos, premiums paid, claims made or vehicles invoWed
in the occurrence, the most we wflH pay for the total) of aH damages resufting from any one occurrence is the
Each Occurrence Limit shown in the schedUe of this endorsement.
2. The Aggregate Limit shown in the schedWe of this endorsement is the most we wflH pay for the sum of aH
damages under this Coverage Part. The Aggregate Limit shown in the schedWe of this endorsement is included
within the General) Aggregate Limit shown in the policy declarations. The General) Aggregate Limit is the most we
wflH pay for the sum of aH damages under aH Coverage Parts provided within this policy except damages because
of bodily injury or property damage included in the products-completedl operations(hazard).
ENV-7110(02-015) Page 2 of 3
With respect to the insurance provided by this endorsement, the COMMERCIAL GENERAL LIABILITY COVERAGE
FORM, SECTION IV - COMMERCIAL GENERAL LIABILITY CONIDITIONIS are not changed with respect to WIRED
AUTO LIABILITY or NIONI-OWNIED AUTO LIABILITY Insurance.
With respect to the insurance provided by this endorsement, the COMMERCIAL GENERAL LIABILITY COVERAGE
FORM, SECTION V. DEFINIITIONIS is amended as fdlllows:
A. Item 9. Insuaredl contract is amended to include the f6lowing:
f. That part of any contract or agreement entered into, as part of your business, pertaining to the rental) or (lease, by
you or any of your employees, of any auto. However, such contract or agreement shall)) not be considered an
insuaredl contract to the extent that it obfigates you or any of your employees to pay for property damage to any
auto rented or(leased by you or any of your employees.
An Insured contract does not include that part of any contract or agreement:
1. That indemnifies a raflroad for bodlily injury or property damage arising out of construction or demolition
operations, within 50 feet of any raflroad property and affecting any railroad bridge or trestle, tracks, roadbeds,
tunn6l, underpass or crossing; or
2. That pertains to the Moan, (lease or rental) of an auto to you or any of your employees, if the auto is
�loaned, (leased or rented with a dhver; or
3. That holds a person or organization engaged in the business of transporting property by auto for hire harmlless
for your use of a covered auto over a route or territory that person or organization is authohzed to serve by
pubfic authority.
B. The f6lowing additionall DEFINIITIONIS are added:
1. Auto business means the business or occupation of sd1fing, repairing, servicing, storing or parking autos.
2. Domestic employment means the emplloyment of persons engaged in househd1d or domestic work performed
phncipalllly in connection with resident4l premises.
3. Hired auto means any auto you (lease, hire or borrow. This does not include:
a. any auto you (lease, hire or borrow from any of your emplloyees or members of their househ6lds, or from any
of your partners or executive officers;
b. any substitute, repllacement or extra auto needed to meet seasonal) or other needs, under a Ileasing or rental)
agreement that requires you to provide direct primary insurance for the (lessor; or
c. any auto you (lease, hire, rent or borrow for a period of time (longer than six(6) months.
. Non-ownedl auto means any auto you do not own, (lease, hire or borrow which is used in connection with your
business. This includes autos owned by your employees, partners (if you are a partnership), members (if you are
a(limited (liability company), or members of their househoNs but orally whfle used in your business.
A11 other terms and conditions remain the same.
ENV-7110(02-015) Page 3 of 3
