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PROOF OF INSURANCE (2018) CLOSED DATE(MMIDDIYYYY) ACDORO A. . CERTIFICATE OF LIABILITY INSURANCE 07/07/2017 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). PRODUCER 1-800-247-7756 CONTACT NAME: Holmes Murphy & Assoc - WDM FX ANkd9, AIC S No) aft PO Box 9207 ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC# Des Moines, IA 50306-9207 � INSURER A:: Employers Mutual Casualty Company A/XIV 21415 INSURED INSURER B: Continental Insurance Company (CNA) A/X5'35289 Musco Sports Lighting, LLC INSURER C Attn: Carrie Ferguson P.O. Box 808 INSURER D: INSURER E Oskaloosa, IA 52577 INSURER F: COVERAGES CERTIFICATE NUMBER: 50315407 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. - em � ., .y .......t............................................................................................................................................................................ INSR TYPE OF INSURANCE ANDLUBR POLICY'EEE I OLII(,Y F'�X1 LIMITS LTR INSO 1AIVD POLICY NUMBER (MMIDDIYYYY)y,_,(MMfDN?RYXXY;p A X COMMERCIAL GENERAL LIABILITY 2D5362518 07/01/17 07/01/18 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ract al L ab OCCUR lity MED EXP(Any(one person) �$ 15,000 0 ...X.........Contractual L ( N `(b i�w �, ) � 300,00.. .... PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGA FE $ 2,000,000 POLICY I....X...l O- I...X.....JLOC PRODUCTS-COMP/OP AGO $ 2,000,000 JECT ()"B p)I A $ A AUTOMOBILE LIABILITY 2E5362518 07/01/17 07/01/18 COMBINED SINGLE LIMII $ 1,000,000 Ta accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _,. AUTOS AU f GS X X NON()VVIVEfJ PROPERTY DAMAGE. HIRED AUTOS AUTOS i(Per accident),,,,,,,,,,,,,,,, $ $ • X UMBRELLA LIAB � 00GUR CUE6042800716 07/01/17 07/01/18 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS MADE AGGREGATE $ 10,000,000 ' DFD I X I RFTF.NTION$10,000, " $, • • WORKERS ANFDICER/MOE®OR/PACNOERE ECU FIVE (;� NIA 2P5362518 (Florida)ey) 07/01/17 07/01/18 E�L�EACH IACCIDENT I],FR, $ 500,000 • (Mandatory In NH) ( � 2S5362518 (Non Dedt Stat a87/01/17 07/01/18 E L-.DISEASE EA EMF LOYEE, $ 500,000 A DR9CRPTIONOFOPFRATIONSbelow 2Z5362518(All Other Stata87/01/17 07/01/18 r..L DISEASE--.F.�OLICw � $ 5.�� 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Musco Project SVC-390952 - Campus E1 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. Waiver of subrogation applies in favor of the City of E1 Segundo with respect to the Workers Compensation when required by written contract. 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(2014101) The ACORD name and logo are registered marks of ACORD rroycewdsm 50315407 COMMERCIAt GENERAL I 1AffiLITY 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 Named Of Additional Insured Person(s) Or Locations(s) Of Covered Operations Organization ----------- ................... - "I City of El Segundo Campus El Segundo Athletic Fields 350 Main Street El. Segundo, CA 90245 .......... Information required to complete this Schedule, if not shown above,will be shown in the Declarations. ............... A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an addibonal insured the per or additional insureds, the following additional or,ganization(s) shown In the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insul,ance does not apply to "bodily injury" or darnage" or "personal and advertising injury" ,property damage" occurring after-, caused, in whole or in part, 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 performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) 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(I-15) lnciudes copyrighted material of ISO Properties,Inc.with Its pevnilssion. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC OD 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 .M4Y 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 Effective Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. h.