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PROOF OF INSURANCE (2017) CLOSED AC" CERTIFICATE OF LIABILITY INSURANCE DATE 5/15 /2017 ' �. os/1s/2o17 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 1-800-247-7756 (CONTACT NAMV Holmes Murphy & Assoc wDM 1 ONE Xt! PAR AIXC.a..NoI2 E-MAIL PO Box 9207 ADR Rf:SS: _..........__.......... IN,S9RER(S)AFFORDING COVERAGE NAIL# Des Moines IA 50306-9207 INSURERA: Employers Mutual Casualty Company at1 A ......................... �.....�' /XIV 21415 INSURED INSURERB: Continental Insurance Company (CNA) A/X11'38318 Musco Sports Lighting, LLC Attn: Carrie Ferguson INSURER C: ................................................... _......�................................................,,,,, P.O. BOX 808 INSURER D: INSURER E ......................... Oskaloosa, IA 52577 INSURER F: COVERAGES CERTIFICATE NUMBER: 49833152 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. ILTR kD TYPE OF INSURANCE.................................. D 'BUSK POLICY NUMBER I'MMIDDIYYYYV WM//dJ��NYYYL.............................. LIMITS ................................................,,,,,,,,,,,,,,,,, A X COMMERCIAL GENERAL LIABILITY 2D5362517 07/01/16 07/01/17 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR F � $ 300,000.......... ............................... X Contractual Liability MED EXP(Any one person) $ 15,000 .................... PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE PLIMIT APPLIES POLICY JECT R I LOC PRODUCTSGCOMP//OPAGG $ 2,00 E PER: GE 0,000 OTHER $ A AUTOMOBILE LIABILITY 2E5362517 01 07 16 07/01/17 COMBINED SINGLE/ / �c�,c,istfrrol).. . LIMIT $ 1,000,000....................... X ANY AUTO BODILY INJURY(Per person) $ BODILY INJUR....,,,,,,,, ALL OWNED SCHEDULED Y Per accident $ AUTOS AUTOS ( ) (Pad'l Y DAMAGE X HIRED AUTO AUTOS S X ED rDacr,i,afant) $ B X UMBRELLA LAB X OCCUR CUE6042800716 07/01/16 07/01/17 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE................. $ 10,000,.0.0.0 DED RETENTION$ .................... X 10 ....O..O.0............... $ WORKERS COMPENSATION X PER OTH- A AND EMPLOYERS'LIABILITY Y/N 2M5362517 (New Jersey) 07/01/16 07/01/17 ___ STATI_ITE �,ER A ANY A (MandatoryinBEREX PROPRIETOR/PARTNER/EXECUTIVE 255362517 (NonrDedt Stateb7/01/16 07/01/17 EL DSEASECDgET $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A EMPLOYEE $ 500,000 A I DESCRIPTION OF 2Z5362517(A11 Other State&7/01/16 07/01/17 E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Musco Project SVC-390952 - Campus El Segundo Athletic Fields City of El Segundo is named as an Additional Insured with respect to the General Liability when required by written contract or agreement. y-, J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 I USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD rroycewdsm dQR-271 S') COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED m OWNERS, LESSEES OR CONTRACTORS - SCHEDULE® PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHE 3ULE Named Of Additional Insured Person(s) Or Locations(s) Of Covered Operations Organization(s): City of E1 Segundo Campus El Segundo Athletic Fields 350 Main Street E1. Segundo, CA 90245 information required to complete this Schedule,q ' p !e, if not shown above,will be shown in the Declarations. A. Section Il — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury"„ "property This insurance does not apply to "bodily injury" or dar-nage" or "personal and advertising in)ury" property damage"occurring after: caused, in whole or in hart, by'. 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service,, behalf; maintenance or repairs) to be performed by or in the peilofmance of your ongoing operations for on behalf of the additional insured(,$) at the the additional insureds) at the location(s) location of the covered operations has been designated above, completed;or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG7695M(1-15) Includes copyrighted material of ISO Properties,Inc.with its permission. Page 1 of l WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-a4) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not en- force our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effeclive Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. IK