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PROOF OF INSURANCE (2017) CLOSED Client#:974 AKMCONSUL
IDD/YYYY)
DATE(MM
ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DA TE(MM2016
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 poli'cy(les)must he 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).
��yylIyy
PRODUCER k%lk.T Nancy Ferrick
Dealey, Renton&Associates PHONE 510 465-3090 FAIL 510 452-2193
P. O.Box 12675 mRnl�oA_e tt: (nr , ?w!1............ .-
noagl .,nferrick rbdealeyrenton.com
Oakland, CA 94604-2675 _ INSURERISIAFFOROINGCOVERAGE NAIL#
510 465-3090 w8URER I'll
A Sentinel ra
Insu ..
nce Co.LTD 11000
INSURED INSURER B:Trumbull Insurance Company 27120
AKM Consulting Engineers, Inc. MSUR"ER"C:Travelers Casualty""&Surety Co. 31194
553 Wald Street
Irvine,CA 92618-4627 INSURER D:
INSURER E:
INSURER 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 POLICY PERIOD I
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 BY PAID CLAIMS,
SR X XR 5736WLU8719 NUMBER 09�.� �...--.C.... . R TEE LIMITS
IAbbL .._.
II�SR OLICY EFI POL %p
L TYPE OF INSURANCE & � fp,1WD YYY)
_ MIDD/YWY
iA 'X COMMERCIAL GENERAL LIABILITY /20/2016109/20/201 kA�C:1�10C°�CCURR�L CE 52,000,000
CLAIMS-MADE XJ OCCUR r�I'$LR 15r� En:'4r u�rY ncti),.,. $1,000,000
MED EXP(Any one person) $10,000
.. ..PER 5.NAL&ADV INJURY s2,00,000
........... IT
.......... ..
GEN°L AGGREGATE LIMIT APPLIES PER GENERAL GENERAL AGGREGATE 54,000,000
PRO.
POLICY .X�JECT _..._,I O PRODUCTS-COMP/OPAGG s4}000,OOO
OTHER $
A AUTOMOBILE LIABILITY X X 57SBWLU8719 '09/20/2016 09/2012017 4 OrAS Nro'"N' LF $2 a OOO?OOO
UMMf1. .,
.... ra ddcCa,SflarllX„, , ..,. ....., .
ANY AUTO BODILY INJURY(Per person) 5
ALL OWNED "SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
ro ER7Y�IA,MroA'GJ, 5
X HIRED AUTOS X AO®WPJED II r c,dglll "
A X EXCESS ABAB I X OCCUR X X 57SBWLU8719 09120/2016 0912012017 00,000
g EACH OCCURRENCE 51 O
y CLAIMS MADE AGGREGATE $1,0100,000
WORKERS COMP SATI {^ul��� X� �57WEGZSO 5 0 ������09/20/2016 09120/2017 V �
�Irr rIl IIF,
B.,, ANYPROMEMTEREAXRTNER/EXECUTIVE�YN 25 1 II/V1IA(�;If°11IIJ1 w $1,0 ,
W COMPENSATION F
CLUOE07 NIA OO
,000
(Mandatory In NH) 1 Dly,I AEr-.-A Ir NI('I°OYF E 51 000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below F..:I... 1:'1;°IEA,,I_ I1('NLW"e LIMI I 51,000,000
C Professional 1 105344511 09/20/2016 09/20/2017 $2,000,000 per Claim
Liability $2,000,000 Annl Aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
General Liability Policy excludes claims arising out of the performance of professional services.
All Operations of the Named Insured.City of El Segundo, its officers,officials,employees and volunteers
are named as Additional Insured as respects General Liability coverage. Insurance is Primary/Non
Contributory per policy form wording.Waiver of Subrogation applies to Workers'Compensation.
CERTIFICATE HOLDER CANCELLATION
ANY City of El Segundo THE SHOULD EXPIRATTIIONH DATE V TH REOFE NOTICEI WILL CBE CDELIVERED NE
350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo,CA 90245-3895
AUTHfO�RIZED REPRESENTATIVE
©1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1862977/M1820079 AZM
Insured: AKVI Consulting Engineers,Inc.
Insurer: Sentinel Insurance Cc LTD
Policy Number: 57SBWLUB719
Policy Effective Date: 09/20/2016
City of El Segundo,its officers,officials,employees and valunteers,
Additional Insured:
EXCERPTS FROM: Hartford Form SS 00 08 04 05
BUSINESS" L ABILITY COVE AC"I FORM
C.WHO IS AN INSURED
S.Additional Insureds When Required By Written Contract,Written Agreement Or Permit
The person(s)or organization(s)identified in Paragraphs a.through f. below are additional insureds when
you have agreed, in a written contract,written agreement or because of a permit issued by a state or
political subdivision,that such person or organization be added as an additional insured on your policy,
provided the injury or damage occurs subsequent to the execution of the contract or agreement,or the
issuance of the permit. A person or organization is an additional insured under this provision only for that
period of time required by the contract, agreement or permit.
f. Any Other Party
(1)Any other person or organization who is not an insured under Paragraphs a.through e,above, but only
with respect to liability for"bodily injury, "property damage"or"personal and advertising injury"caused, in
whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
(a)In the performance of your ongoing operations;
(b) In connection with your premises owned by or rented to you; or
(c)In connection with"your work"and included within the"products-completed operations hazard, but
only if
(i)The written contract or written agreement requires you to provide such coverage to such
additional insured;and
(ii)This Coverage Part provides coverage for"bodily injury"or"property damage"included within the
"products-completed operations hazard.
(2)With respect to the insurance afforded to these additional insureds,this insurance does not apply to:
"Bodily injury, "property damage"or"personal and advertising injury"arising out of the rendering of,or the
failure to render,any professional architectural,engineering or surveying services, including: inspection, or
engineering
E.S.Separation of Insureds
Except with respect to the Limits of Insurance, and any rights or duties specifically assigned
in this policy to the first Named Insured, this insurance applies:
a.As if each Named Insured were the only Named Insured; and
b. Separately to each insured against whom a claim is made or"suit"is brought.
E.7.b.(7).(b) Primary And Non-Contributory To Other Insurance When Required By Contract
If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-
contributory with the additional insured's own insurance,this insurance is primary and we will not seek
contribution from that other insurance.
E.8.b. Waiver Of Rights Of Recovery(Waiver Of Subrogation)
If the insured has waived any rights of recovery against any person or organization for all or part of any
payment, including Supplementary Payments,we have made under this Coverage Part,we also waive that
right,provided the insured waived their rights of recovery against such person or organization in a contract,
agreement or permit that was executed prior to the injury or damage.
EXCERPT FROM Hartford Form SS 04 38 06 01
HIRED AUTO AND NON-OWNED AUTO
B.With respect to the operation of a"non-owned auto",WHO IS AN INSURED is replaced by the following:
The following are"insureds":
d. Anyone liable for the conduct of an"insured", but only to the extent of that liability.
Insured: AKM Consulting Engineers,Inc.
Policy Number: 57WEGZS0250
Effective Date: 09/20/2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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 to the
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 % of the California workers' compensation premium
otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Ref:Venturi Meter Evaluation Project.
City of El Segundo
350 Main Street
El Segundo,CA 90245-3895
Countersigned by 4-c�"
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: Policy Expiration Date: