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PROOF OF INSURANCE (2017 - 2018) CLOSED A 0 I DATE(MMIDDIYYYY) Ill 6/28/ OF LIABILITY INSURANCE U 6/28/2017 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). 'CON'T'ACT' . PRODUCER NAME: Tina Cowie Cornerstone Specialty Insurance Services, Inc. PHONE (714)731-7700 P y FAX (714)731-7750 LMA I`lta,FRt): ((ic.Nn). ..., 14252 Culver Drive A299 Ptins@cornerstones ecialt com INSURER(S)AFFORDING COVERAGE NAIC# Irvine CA 92604INSURER A:Travelers Property Casualty Co 25674 , INSURED INSURERB:Travelers Casualty & Surety Co. of 19046 HAYER CONSULTANTS, INC. INSURER C: 4067 Hardwick St. INSURER D: PNB 250 INSURER E: Lakewood CA 90712 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17/18 COVERAGES 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 SUBRI' POLICY EFF POLICY EXP LIMITS LTR It ,LL Wvt) POLICY NUMBER (MMIOOIYYYIII (MNUOD/VYYYI X, COMMERCIAL GENERAL LIABILITY 1,000,000 0,DA MAC ['0 OCCURRENCE I^NTren x) A CLAIMS-MADE X OCCUR PREMIE ( 1,000,000 X ADDTL INSURED/PRIMARY X Y 680-2J009914-17 6/13/2017 6/13/2018 MED EXP(Any one person) $ 5,000 X BLNKT WVR OF SUBRO PER FORM # CGD3810915 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: AS REQUIRED BY WRITTEN GENERAL AGGREGATE $ 2,000,000 POLICY X I k LOC CONTRACT2,000,000 PRODUCTS-COMPlOPAGG $ 0THI-;R, CONTRACTUAL LIAB INCLD $ AUTOMOBILE LIABILITY COMHMEIU'SINGLE I..IMIT $ INCLUDED (Ea oCnjdenu A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS 0 AUTOS X Y 680-2J009914-17 6/13/2017 6/13/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE X HIRED AUTOS „R AUTOS Per accident), $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,.000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000.000 DED � X ( RETENTION$ 0 CUP-6536Y635-17 6/13/2017 6/13/2018 $ STATUTE IRH ... . E YIN WORKERS COMPENSATION ,ITE AND EMPLOYERS'LIABILITY ���������� , L. f ,, (MandatoryEL EACH ACCIDENT $ in HtlEXCLUDED�ANY ECUTIVE NIA EL DISEASE-EA EMPLOYEE: If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ B Professional Liability 106639088 12/1/2016 12/1/2017 Each Claim $2,000,000 Claims Made Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of El Segundo is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk' s Office ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Patricia Harada 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 Tina Cowie/SGL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r9mam t HAYER CONSULTANTS INC. POLICY#680-21009914-17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1, The following is added to SECTION II — WHO IS h. This insurance does not apply to "bodily AN INSURED: injury' or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance" to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for"bodily injury", coverage for that additional insured, and then "property damage" or"personal injury'; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of you "property damage"that occurs before the end or your subcontractor in the performance of of the period of time for which the "written ,.your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period,whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured Cl. For "bodily injury", "property damage" or is excess over any valid and collectible other insurance, whether primary, excess, contingent or "personal injury" for which such person or on any other basis, that is available to the organization has assumed liability in a additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured This endorsement does not increase the limits is limited as follows: of insurance described in Section III — Limits e. This insurance does not apply on any basis to Of Insurance. any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". CG D3 81 09 15 u 2015 The Travelers Indemnity Company.All rights reserved. Page 1 Of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission HAYER CONSULTANTS INC. POLICY#680-2J009914-17 requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs;and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 u 2015 The Travelers Indemnity Company.All rights reserved. Page 1 Of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission HAYER CONSULTANTS INC. POLICY#680-21009914-17 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV— COMMERCIAL GENERAL ,Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury' arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a "written contract requiring insurance" with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury' or c. Before the end of the policy period. "property damage" occurs, or the"personal injury" offense is committed. Page 2 of 2 G 2015 The Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission POLICYHOLDER COPY SC P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 05-24-2017 GROUP: POLICY NUMBER: 9100543-2017 CERTIFICATE ID: 8 CERTIFICATE EXPIRES: 05-24-2018 05-24-2017/05-24-2018 CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, EMPLOYER HAYER CONSULTANTS, INC. SC 4087 HARDWICK ST PMB 250 LAKEWOOD CA 90712 [P15,HO] (REV.7-2014) PRINTED : 08-29-2017 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9100543-17 A RENEWAL SC PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JULY 17, 2017 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MAY 24, 2018 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HAYER CONSULTANTS, INC. 4067 HARDWICK ST PMB 250 LAKEWOOD, CA 90712 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, HAVER CONSULTANTS, 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: JULY 19, 2017 2570 AUTHORIZED REfll SI'N'I" IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD OP 217