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PROOF OF INSURANCE (2018 - 2018) CLOSED
""+ry LAYNE-2 OP ID: SF CERTIFICATE OF LIABILITY INSURANCE DATE 06/22/17rr) ...............__..........................................................................wr_...- ......................................................_..... ... .. ............................................. 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 C 925-977-9224 ONT 925-977-9220 0,A, ACT "" Easterly Surety&Ins.Svcs.lnc PHONE Fax 56 Mayhew Way (A/C,No,Ext): (A/C,No). Walnut Creek„CA 94597 E-MAIL Kevin P.Easterly ADDRESS` INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:James River Insurance Company 12203 INSURED C C Layne&Sons INSURER B:State Comp.Ins.Fund of Ca 35076 C.Craig Layne INSURER C 213 Richmond Street El Segundo,CA 90204 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 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 ADDL SURR: POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYV MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 TO $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X '00528485 04/14/17 04/14/18 DAMAGE RENTED I PREMSE (Ea oeci.,rf&s,ej $ 50,000,, CLAIMS-MADE B X I OCCUR MED EXP(Any one person) $ 1,0001 PERSONAL&ADV INJURY $ 1,000,000, GENERAL AGGREGATE $ 2,000,0061 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,0001 POLICY $ ,.......... G ..Y r.X a �....J.rC T ICI o LOC ............................._.................................................................................................................,...............,-�.�................... ._, _- .__._-..................................................... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per,accd W) $ ......... ...... .... ..... ..... .... .... .................. ..... ...-,.. .......... ........._.,,� ............ .......,.._. ... UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAB CLAIMS-MADE XL66037005 04114/17 04/14/18 AGGREGATE $ 4,000,000 DED I X I IRE'I EN"fI'ON$ i$ ._. .............................................................................................................................................................................................................................................................,........._.......... ..........ww..._.............................. ... WORKERS COMPENSATION WC STATU- OTH q AND EMPLOYERS'LIABILITY X T R.Y.I,IMIT11 X f_FR II B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 9088031-2017 02/01/17 02101/18 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMITyd$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: REMOVE & REPLACE CARPET AT FIRE STATION #1. JOB NO. PW 17-29. CITY OF EL SEGUNDO, ITS OFFICIALS, AGENTS, VOLUNTEERS AND EMPLOYEES ARE NAMED AS ADDITIONAL INUREDS PER THE ATTACHED ENDORSEMENT FORMS CG2010 0704 AND CG2037 0704. THIS INSURANCE IS PRIMARY AND NON—CONTRIBUTORY. WAIVERS OF SUBROGATION APPLY. CERTIFICATE HOLDER CANCELLATION ELSEGUN _� _WWWWW..........�.. _.�._ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN ST EL SEGUNDO, CA 90245 " AUTHORIZED REPRESENTATIVE v I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 00052848-5 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orclanization(s): Location(s)Of Covered Operations Where required by written contract or written agreement. All operations of the Named Insured:", Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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 exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily or damage" or "personal and advertising injury" pp y y in ur y caused, in whole or in part, by: property damage occurring after: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: 00052848-5 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s): tions Where required by written contract or written All operations of the Named Insured. agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II—Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Organization(s: If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US 04-10 Page 1 of 1 POLICY NUMBER: 00052848-5 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where required by written contract or written agreement. . .....wawa.... Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of We waive any right of recovery we may have against Rights Of Recovery Against Others To Us of the person or organization shown in the Schedule Section IV—Conditions: 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 organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9088031-17 STATE RENEWAL NA FUND 0-23-53-02 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JUNE 21 , 2017 AT 12. 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING FEBRUARY 1 , 2018 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME C C LAYNE & SONS INC 213 RICHMOND ST EL SEGUNDO, CA 90245 XvIx ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, C C LAYNE & SONS INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JUNE 23, 2017 2570 Awll'PM11RI'2E'L9 IEPIISEIUT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217 C CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD ) 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 CONTACT Remon Wasfi^N -_ NA�16 „ A gRs 310-322-1132 °310-640-1057 StateFarm 3737) 0TORRANCE BLVD STE 201 PHONE rernon.wasfi.k0w3t m a sPalel..arm.co ca TORRANCE, CA 90503 Mutual AFFORDING COVERAGE NAIC# INSURERA,:Stale Farm t ............. al Automobile Insurance Company 25178 I NSUR ED CC LAYNE&SONS IN_SURERB: 213 RICHMOND ST. INSURER C: ., EL SEGUNDO, CA 90245 -3719 INSURERD: 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 INDICATED. NOTWTHSTANDING 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. LTK TYPE OF INSURANCE ..,..iANe�,.s.U.e.R . -'POLICYNUMBER^. ((MM1UDeYYYY1 IPi30..1D(YY�...-�� . .... ..... IhtMdDO(YY'Y'Yi LIMITS COMMERCIAL GENERAL LIABILITY D�OCCURRENCE� . _ CLAIMS-MADE U OCCUR DAMA6 FSb aOATED ccl _ a �. ..... S _ ....................... y one person ADVINJURY .....�.....W__ __. _...,. ... P SONA L& S GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY I LOC PR PRO- ❑ 3 JE'C'r ODUCTS-COMP/OPAGG ..................... Or1dER; 5 A AUTOMOBILE LIABILITY COMBINED SMGLE LIMIT S 1,000,000 ..... Y 470 7387-C26-75C 03126!2017 03!28/2018 ANY AUTO BODILY INJURY(Per person) S HIRED AUTOS ALL OWNED SCHEDULED S X A NON-OWNED (PRO ER�DAMAGC _._ _—_ AUTOS ar, ec1J� 1 3 (Per aca _.. ...„ UNINS MOTORIST s 30,000 UMBRELLA LtA6 LI AGGREGAURRENCE w $ AB CLAIMS-MADE EXCESS OCCUR _ .._p..._. _� Ir Q .. TE $..,. DED RETENTIONS f AND EMPLOYERS*UABIL[TY YIN . .. . mm ...I.,STAT�ITE ....1 OR .. WORKERS COMPENSATION PER OTH- ACCIDENT $ ANY FMBE EXCLUDED? r `1 NIA E.L.L SCH.AEA...................................w.... a In NH' I— f E DISEASE-EA EMPLOYE $ D.SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S ..................w. ..,...._.,.w., DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ir more space Is required) 470 7387-C26-75C,2000 FORD F250 SD PICKUP,VIN:3FTNX20LXYMA33765 CERTIFICATE HOLDER CANCELLATION CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO,CA 90245 AUTHORIZE NP161� NT ATIVEi gb-201 ACORD OR 'I RATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014