PROOF OF INSURANCE (2018) CLOSED (2) STEPH-1 OP ID: RH
DATE(WUDDIYYYY)CERTIFICATE OF LIABILITY INSURANCE I 03102/20/7
THIS CERTIFICATE 13 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: I1 the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION 18 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 andorsement(s).
PRODUCER 'C NNIAC1' Certificate Dept
Insurance
Wright,
Palma Ave OOr s(' NMertl4lca s fclnsurance.com .V..� ,.yp)p 7.14-283-1997 _
Yorba Linda,CA 82887
John Carter CIC INSURERS!AFFORDING COVERAGE MAIC 1
INSURERA:Travelers Indemnity Co of CT 25682
INSURED Stephen Doreck Equipment *nuRER B:Travelers Property Casualty Co 25674
Rentals,Inc.,Doreck Construc INel~c:Westchester Surplus Lines Ins 10172
8075 Telegraph Road --—
Pico Rivera,CA 80660 INSURER D:Ohio Security Insurance Co _24082
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE AGLNL va11 ' IO (SWM 1111p rT I
R" �} POLICY NUMBER QMFIMY, LI MfT#
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f !,ON,
,A X �CLAJMSrMAVE M,OCCUR X X DT22-CO-7200P538 TCT-17 03101/2017 03/01/2018 UAMW�t,10Ift?'!Itu f 300,00(
ontraCtual L('ab MED EXP(Any one person) f 5,00(
C X Pollution Liabil G27153136004 03/01/2017 103/0112018 PERSONAL&ADV INJURY f 1,000,
GE,N'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE f 2,000,
POLICY ®PRO-
❑LOC I PRODUCTS-COMPlOPAGG f $000,000
OTHER Pollution S 2,0001000
- AUTOMOBILE LIABILITY COMBINED SIT,*1.ELIIAIT f ,,1 000 000
�� ��
B ANY AUTO X X DT-S10-8D457897-711-47 03101/2017 03/01/2018 BODILY INJURY(Per person) i
/VVI ALL OWNED SCHEDULED
AUTOS A1,AO'S BODILY INJURY(Per accident) f
XW.M-OWNED TIM
HIRED AUTOS ply,+, (Po(A.gz,.4cdamlp
X HiredAuto i v amcb o Comp/Coll f $1,000 ev
.......... UMBRELLA LU16 X .. .... _...._......_,....__....................................0w...........................
_ OCCUR 4 - EACH OCCURRENCE f 5,000.000
B X EICCEssLUB CLAIMS-MADE CUP-2J30068A-17.26 03/01/2017 03/018018 AGGREGATE f 3,000,000
DIED
ON PEk
B AND MPLOYEANY ��RETENTION
NE rEk) rv'IIro�E' YIN j� DTJ-UB-7200P538-17 03/01/2017 03!018018 SHAHATE_...
AND EMPLOYERS'lU1BILI71'
UPPIiC'CR l,r MBE'R C o''.Ur'A L^ N l A E L EACH CCII NT f 1,000,00q
__._.....................m...... !... _,
(MandMoty In NH) USLd�H COVERAGE INCLUDE E L DISEASE-EA EMPLOYEE f 1,000,0001
PP yor;.�Pelltuppry wradol .... ....w.Y..-
!�F,.Sd:�P';`4P'7tl�e"aN A'ar''(;
"°`°`"°°°' STEPHA PAO*2
NOTEPAD: INNUVINAME Stephen Dorock Equipment OP ID: RH DOW ON02120117
WORKERS COMPENSATION. JOB: WATER MAIN 714PROVEMETS - MARIPOSA AVE Pw
17-03 SDE JOB # 2017-01. 30 DAY WRITTEN NOTICE OF CANCELLATION WILL
BE GISTO THE CERTIFICATE HOLDER, 10 DAY 'O -PAYMENT OF PREMIUM.
...........
tnsured: Doreck Construction,Inc.;Stephen Doreck Equipment Rentals,Inc.
Pollcy#: DT -CO-7 0P5384CT-17
THIS E'. EM C E8 THE POLJOY. KFASE RNO IT Y.
ADDITIONAL INSURED—OWNERS,,, LESSEES OR
CONTRACTORS — SCHEDULED PERSON OR
ORGANIZATION — C FOPERATIONS . NG IN
OPERATIONS AS SCHEDULED
TW srx nt oweliffos hwuranoo proAdledl un4w#w sV:
OOMMERWL DENERALUASUM COVERAOE PART
N Of AddftfomlIns
Or art s): Location And Description,Of OtIeruflom
CITY OF EL SEGUN DO,ITS OFFICERS,OFFICIALS, JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB rr 2017-01.
350 MAIN STREET,EL SEGUNDO,CA 80245
A. Section U.—Who Is An'Insured Is arra ed b hid6de the s)or ) w(s)shown In to
Sohedoia,(aged I , bit only wth respect to:
L Uabiltty*w Obodlly b*W or*property dwrfte caused,In whda Or In pw%by"yaw worst'at
t?te and In the w6edule of We,endoreemat peftmod brtw
""aud onrel frumvecr snrt In 111" ` uct
and such Parson(i)at orasnIzatIm(e)tove ep In, In al or sigmemat OW!
such e)or n s)be no as an an your Qolioy.
IL LkNky for 1bodlly kW."property derm9e.or and Inn .In
vdide Or In part by:
a.Your acts or orn ;or
b.The arts or onitseloto of Omo ecting on yaw
In the I"or"M no IN on I I (e)at the wation(a)
B. Seatlon IY — CammmW Owwal UalAft Condidws, 4. r Irdwance Is arnended.and the
foft% tO added;
If you aro requIlmdW to prfmsry ,the kwurarm aftnJed by this Ccr*%
erego Part for the'" l i -shownn In the Schedule we peamry I and we wm not
ccs **rn any a thsr lrt to Met ft w>ted
ALL OTHER TERMS AND CONDITIONS OF THE POLICY RREMAIN UNCHANGED.
U48MI08 Indudead mist d ISO Poopelfts.,Ina..2W4 Pop 1 of 1
V th Ion,
Insured: Doreck CominidiOn.Ute.:Stephen Dotack EQuipmwt Rentals.Int- MMMERCX GENERAL LIABILM
POW* DT22-CO-720OP538-TCT-17
TH1$ENDOR39MENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS) CfTYOI'FL SFOUNDO,rTS OFFICERS,OIFICIALS,
EMPLOYCES,AOENTS AND VOLUNTEERS
350 MAIN STREET,EL SEGUNDO.CA 90245
This endorsement modfts kourance provided wider the knowing:
COMMERCIAL GENEM LIABILITY COVERAGE PART JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
PW 17-03,SDE JCG#2017-01.
1. WHO 13 AN INSUREU—(Section tl)Is amended c) The Inulrarm proVided to the addill4rial In.
to Include any peor orgy tion that you stired does root apply to Oboduy Ir4ury, or
agree in a *wrfflen contract requiring;, Insurance *prop rt damage caused by 'your wode
to includ*as an additional Insured on this Cover- and Included In the *products-comps eted, op.
age Part,but: orations hazard' Unless the "Writtari oontract
a) Only with respect to liability for"bodily kkjuryb, (equiring ktsuranco* specIfW44 requires you
'property,dornage*or'personal Injuryo;and to provide such covemon for that additional
ftural,, and then the insurance provided to
b) If. and only to the Went that. the Injury or the additional Insured applies only to such
damage Is caused by acts or amlssion$ of 'bodily InW or 'property damage" that oo-
you or yow subcontractor In the performance cuts, before the end of ft pwW rat time tot
of myow work" to which the Wlten witrAct Which the 'written contract requiring Insur.
requiring lnsurancW applies. The poison or ance requires you to provids sud'i rAwarogo
or9nnization does not quality as an additional or the end of the policy period,whichever K
Insured with respect to ft Independent acts Cartier.
or ornisslom of such pareon or o(gatilzatlon. 3. The Insurance provided to tine additional insured
2. The Insurance proVided to the addidionall insured by this crulomernent to exceea over anyvalld anal
by this andorsoment Is"Od as follow. collectible "Other Insurance, whether primary,
a) In the avant 90t line UrnIto of InWifMce of excess, contingent or on any other basis, that Is
ilia Coverage Part shown In the Declarations available to the additional Insured for a loss we
exceed the limits of liability required by ft cover txxSer this endorsement. However. It the
*written contract requiring Insurance*, the In- "written contract requiring insurance" specifically
surance provided to the additional Insured requires that this Insurance apply on a primary
sha'lli be limited to the limits of liability re- basis or a pdmM and non-contributoty basis,
quived by that *written contract requiring In- this Insurance Is primary to 'other InsuranW
surance". This endorsement shall not In. available to the additional Insured which covers
crease the limits of Insurance described in that person or organization as a named Insured
Section III—Ufffte Of Insurance. for such lose, and we Wil not share with that
b) The insuranos provided to 111* addtfional In. "other insurance', Burt the Insurance provided to
sured does not apply to"boddy Injuryo,*prop- the additional Insured by this endorsement still Is
arty damage or *personal Injury" arts
out excess mw vW valid and colloolbe 'other Int
of the rendering of, or failure to render, any suranW, whether primary, exams, contingent or
professional ardAectural,ongIneering or sures on any other basis, that Is available to the addi-
tional hisuted when that person nr organization is
voyiryj services,fruIuding', an additional Insured under Such "other Insur-
1. The preparing. approving, or failing to arlow.
prepare or approve, maps, shop draw- 4. An a condition of coverage provided to lineINS, opinjotis, reWts, surveys, flaki or- aWltional Insured by this endorsement-
ders or change orders, or the preparing,
approving. or falling to prepare or ap. a) The additional Insured must alve us written
prove,drawings and specifications,and notice as wort as practicable of an "occur.
tenrW or an offense which may result In a
IL &jpervlvW. inspection, architectural or claim. 'To the extent possible, such notice
engineering activitle& should Include:
CG D2 48 08 05 *2005 The St Nut Travelers Companies, Inc. Page I of 2
COMMERCIAL GENERAL LMILiTY
I. Flaw, when and where the "ocwrrer ce err/provider of*other irwmnW which would
or offense took place; cover tht, additional Insured for a losS vM
IL The names and addresses of any injured covir under No t. However,this
and wttneases;and condidon not affect r Insur.
P ance provided to the additional insured by
Iii. The mature .and kwatlon of any IrJury or this endorsement, Is primary to *Other Insur-
darnage aria ing out of the" rrsoW or ate' available to than additional in ured
offense. which covers that person or organization as a
b) It a claim Is moo or"suit"Is brought againat named insured as described In paragraph 6.
the additional Insured„ Ihre additional Insured above,.
must: The fallowing definition Is added to SECTION V.
L Immedlaiety record Ilia specifics of the —DEFINITIONS:
claim or°sW and the date mcatved;and Vrftn contract roquWtV Insurarxe means
N. Notify us as soon as practicable. that part of any wrftn oontid or agreement
The additional Insured must see to It that we pensunder r ate aired to Include e
In-
receive written notice of the claim ar'ault`as person or orf#ettlurtlon as an additional irw
surad on this Covernge Padprovided that
soon as precdcoWe. the'bodly IvJury*and "'property damage 00-
c) The additional Insured must immediately curs and ft"Personal lt*ry*Is caused by an
send us copies pf at legal papers received In offense committed:
connection with it*claim or'sett". cooperates a After the signing and exewdon of the
with us in the Investigation or safflarnent of ctm*sotoragreement byyou;
the clalm or defense against the 'suit , and
otherwise comply with oil policy conditions.
b. While that part of the oontrsd or
d) The addiGonai insured must tender the de- agreennent Is and
tense and indemnity►of any datm or"suit"to c. Before the erg of the Policy Period.
Page 2 of 2 0 2005 The St.Paul Ttavelars Companies.Inc. CG 02 46 08 05
dririlWe Dwaack C4iwmd1pn Inc;Stay w w c*rwk EQu4mv4 Rer+ters,im COMMERCIAL GENERAL LIABII_rry
Poi ; DT2 -CO.720OP -TCT-17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RM IT CAREFULLY,
CONTRACTORS -�`
CRY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,
EMPLOYEES,AGENTS AND VOLUNYEENNS
This endorsement modMes Inemr=provided under the followkV, 3"014AN STREET„N.1.1'iL6UND0,CA11 45
COMMERCIAL GENERAL LIABILITYRAC':PART JOB: WATER MAN IMPROVEMENTS-MARIPOSAAVE,
PW 17-03,SDE JOB 0 2017-01,
GENERAL DESCRIPTION OF COVERAGE-Pr�aKions A,-H.and
J.-N.of this endomemont broaden otweirage,
and provision I.of this endorsement may lima coverage. The folicAng listing Li a general coverage descripgon
only, Urnitatlone and exclusions may apply to these rverages. lead all the PROVISIONS of this endorsement
carefully to determine rights,duties,aM what to and Is rat covered,
A. Broadened Named Insured H. Additlonall I -Stoats or Polka!Subdivisions
EL Extension of Coverage-"Damage To Pthadess 1. Other hrawence ConcMkm
Ranted To You J. InC Meed SuDD offientaiy P2yments
Perils of fire, caslon,lightning, smoke.water 0 Cast cf ball bards increased to$2.51M
+ Int increased to$340,000 10 Loss of eamings Increased to$=Per day
C. Blar>icet 1Ma4va3r of SubroQaatlon K. KncnMedge and Nogg of OccurMn a or OKerme
D_ Blanket Additional Insured—Managers or Lessors L Unintentiv}Omission
of Premises
E Inddentmt MedloW Matpractiee I& Persorud Ir jury-Assured by Contrswt
F. Extension of Coverage-Bodily Inp,ey N. Blanket Addltiorrel Insured.Lessor of Leased
0. CoMractust Lability-Railroads Equipment
PROVISIONS 3. This Provision A.does not apply to arty per.
A. BROADENED NAMED INSURED wn or manIzation for which coverage is ex.
1. The Named Incurred in Item 1. of the Decima. cluded by endorsement
tions Is as folio": & EXTENSION OF COW AGE — DAuAais TO
The person or PROMISES RENTED TO YOU
p organization named in Item i.
of the Dedaratlons and any organization, I. The last Paragraph of COVERAGE A. BOD.
other than a patrtnomhip,int venture or lin- ILY INJURY AND PROPERTY DAMAGE LI-
[led liabkity company, of Which you rmainta3in ABILITY (Section I _ rages) Is deleted
owanereihlp or in W*h youmaintain Ow rnjor and replaced by the fallowing„
Ity Interest on the offective date of the policy. Exclusloft o.through n.do not apply to
However, coverage Rw any such additional age to promisees while ranted to you, or
or9wftWIon W1111ceese ars of the date, If any. parerily ocauVed by you with pemdsslon of
during the policy period, that you, no lbiVor the owner,caused by:
maintain ownership of,or the ma)orlly interest
�,such� a. Fire;
2. WHO IS AN INSURED (Section N) item 4.w. b' POn'
Is deleted and replaced by the folioWrKr. o. Lightning;
a. Ca mMe under this provision Is afforded d. Smoke resulting from such fns,elxploelon,
only trAll the 1t3M day after you ampAre or ligh ;or
or form the ergerilxatlon or the and of the r. Watw.
policy period,whichaver Is earlier. A separate timit of Insurance Wpiles to this
coverage as deearibed In Section M Um is of
. lrasuraha�p.
CO D316 07 04 Copyright,The Travelers Indemnity Company,2004 Page 1 of e
COMMERCIAL GENERAL LIABILITY
2. This humane does not apply to damage to 6. This Provision B. does not apply if coverage
preftses while rented to you, or temporarily for Damage To Promises Rented To You of
oocupied by you with permission of the COVERAGE A. BODILY INJURY AND
owner.caused by: PROPERTY DAMAGE LIABILITY(Section I—
s. Rupture, bursting, or operation of prey- Cover")Is excludaa>ed by andomement,
Sere r>allef devices; C. BLANKET WAIVER OF SUBROGATION
b. Rupture or bursting due to expansion or We Waive any right of recovery we may have
swaMAng of the contents of any building or agalnst any penton or organization because of
structure,caused by or resulting from waa. payments we make for injury or darmVe arising
I.W. out of: premises or occupled by or rented
c. Explosion of steam boilers. steam pipes, Or loaned td y&A ongoing operallom perlbrmad
steam engines,or ahmm turbines. by you or on!lour half. done under m3 contract
3_ Pasrkonaph 8. of LIMITS OF INSURANCEwith tom` person or�e : *your ; or
(S' tit) Is deleted and repkK*d by the Oym products*. We welve this right w you
: have agreed to do soas OW of a wrtten contract,
ex ted by you before t'hr *bodily Injury"' or
Subject to 6. above, the Damage To Prem- "pmporty damage ocours or the"personal Injury"
ises Rented To You Limit Is the most we will or"advertlsing IrJtW offense Is committed,
pay under COVERAGE A. for the sum of all D. BLANKET ADDITIONAL INSURED — MAMA(;.
damages twAuse of "property damage" to EIS ON LEASCM OF PREMISES
or
temporarily occupied bpremises ey you with permrented to miaaion it)Is a ed to
� WI~iC')'I;g At+t I't'wt�trlRi�t]a
of the owner,caused by:fires;explosion;tight- Include as an lawmel any person or orgerhation
ring; smoke resulting from such fire, explo- ('referred to below an "additional Insured") wile
ckm% or lightning; or water. The Damage To who before
" In n con e -
Promises Rented To You Llnrrit will apply to oil y Nury*or"property dam-
"property darrmeW proximately caused by the age" Occurs or "perrsonal InJury" or "'advertla-
same "oocurrence. whether such damage kV I*W offense Is committed, to name as an
results from: fire; explosion; lightning: snooks aaddltiona l kmred, btd only with resped to liability
resulting from such fire, explosion6 or light- arising out of the ownership,maintenance or use
ning; or water, or any combination of any of of tt°rat part of any premlses premisesleased to you. subject
these causes. to the followingprovisions:
The Damage To Premlms Rented To You 1. lis of Insurance. The limits of insurvince
Limit wia be the higher of: afforded to the additional Insured shalt be the
au. 5300,000;or Umlt which you agmed to provide In the writ-
ten contract.or tits ft is shown on the Decla-
b. The amount shown on the Declarations rations.whichever are less.
for Damage To Premises Rented To You 2 The Insurance afforded to the additional in-
LlnIL sured does not anppty to.,
4. Paragraph a.of the definition of Insured con- a, Any ty In or " de e"
tract (DEFINITIONS —Section V) Is deleted that occurs.or""pe nal Ir)W or"adver.and replaced by the following: ftbv injury caused by an offense which
a. A contract for a lease of prsmlses. Mow- Is committed,slier you cease to be a ten-
ever, that portion or the contract for a ant In ttxM premises;
lease of premien that Indernnifies any b. Arty premises for which coverage Is ex-
person or organization for damage to cluded by endorsement;or
premises while rented to you, or tempo•
rariy o=44ed by you with permission of c. Structural alterations,new construction or
the owner, caused by: fire; eWoslon; dem;AlWn operations perfonned by or on
lightning; arnoke resulting from suds fire. behalf of such:additional Insured,
explosion.or lightning; or water. Is not an 3. The Insurance afforded to the additional ht-
Oinsured contract; scrod Is excess aver any valid and collectible
Page 2 of 8 Copyright,The Travelers Indentnhy Company,2004 4G 0316 07 04
COMMERCIAL GENERAL LIABILITY
"other insurance"evalable to such addhionel together with all related acts or omissions In
insured, unless you have agreed In the writ the furnishing of the services described In
ten contract that this Insurance must be pri- paragraph 1.above to any one person will be
rnary to,or r m-mitributory with. such'other deemed am"occurrance•,
insurance'. 6- This provision E.does note if
E. INCIDENTAL MWFOAL MALPRACTICE the business or oecupetlr�n of my �of
1. Tho following Is added to paragraph 1. Insur- the seeWess dos4tribed In,paragraph 1.
Ing Agreement of COVERAGE A. — BODILY S. The insurance provided by this Provislon E.
INJURY AND PROPERTY DAMAGE LIABIL- shell be excess over any valid end collectible
1TY(Section 1—Coverages): '"other Insurance" available to the irtsurad,
"Bodly 1*ry"arising out of the rendering of, whether ptimsfy, excosss, contingent or on
or fallure to render, the following vAR be any other basis,except for Insuranoe that you
deemed to be caused by an-occurrenW.- bought sp d ioally to apply In excess of the
e. Medical,"ical,denttri.laboratory,x-ray Lindta of Inmuanae shown on the Declarat-
or nursing service, advice or MsUuctlon, tions of this Coverage Part
or the related fumishing of food or bever- F. MENSfON OF COVERAGE — BODILY IN-
ages: JURY
b. The furnishing or dupe** of dugs or The definition of "bodily lnjury' (DEFINITIONS—
medicaL domed, or surgical supplies or Section V)is deleted aril replaced by the follow-
appliances; Iro-
c. First aid:or "Bodily Ir4u y means today injury. mental an-
guish, mental injury, shock fright disabllity, ha-
d. "Good Samaritan services:' As used In millation, sickness or disease sustained by a per.
this Provision E.. "Goad Samaritan ser- ,Induding death resulting km any of(hese at
vicesO are those medical services ren- any We.
dared or provided In an emergency and
for which no remuneration is demanded G. CONTRACTUAL LIABILITY—RAILROADS
or received. 1. Paragraph c.of the deftnWon of'Insured con-
t. Paragraph 2.a.(1)(d) of WHO IS AN IN- tract" (DEFINITIONS — Section V) Is deleted
SURED (Section 0) does not apply to any and replaced by the followkg:
registered nurse, licensed practical nurse, o_ Any emement or license agreement:
emergency medical technldan or paramedic y Paragraph f.(1) of the deffnitfon of 'insured
employed by you, but only while performing contr W (DEFINITIONS — Section V) Is d&-
the services described In paragraph 1.above leted.
and while acting within the soope of their errr AODRIDNIAL INSURED — STATE OR Pt7LiT1-
�oynrertit by year. Any employees rendering CAL SUtI1�NtS10N3—PERMITS
Samaritan services will be deemed to
be acting within the scope of their empl%- WHO IS AN INSURED(Section 11)Is amended to
ment by you. Include as an inured any state or political subdi-
3. The following exclusion Is added to paragraph vislon,subject to the following pwrowlsions:
2. Exclusions of COVERAGE A. — BODILY 1. This insunmce applies only when required to
INJURY AND PROPERTY DAMAGE LIABIL- be provided by you by an ordnance. law or
tTY(Section I—Covoragas). bulling code and only with rases to opera»
(This insurance does not apply to:)Tod6y in- tions performed by you or on your behalf for
jury" or"Pitipahy darneW sifting out of the which the stale or political subdivision has is-
willful violation of a penal statute or ordnamoe sued a permit.
relating to the sale of pharmaceuticals carr►- 2. This insurance does not apply to:
mitted by or with the knoMedpe or consard of a. "gip 1 " dams "
the insured. y �' �e� �'"" *per
-
the Injury"or"advertising INuW arisirg
4. For the purposes of determining the applice- out of operatlons performed for the state
bre limits of insurance, any act or omission or political subdivision;or
CG D316 07 04 Copyright,The Travelers Indemnity Company,2004 Paige 3 of 6
COMMERCIAL.GIENMAL UAEIUTY
b. 'godly Injury" or ""property damage" in- fired under any other polloy,
luded In the"products-completed opera- Including any rnmbrella or excess
tions hazard% popsy.
1. OTHER INSURANCE CONDITION When this, Insurance Is excess, we
A. COMMERCIAL GENERAL UAB&ITY CON- WV a no duty under Coverages A
DmONS (Sec tlon WL paragraph 4. (Otrw or B to defoodl the kwXad agalrM
Irmurence)Is deleted end replaced by the(of. Any"Aub"it any provider of Oather ki-
lawing: svranoe" has a duty to lowland the h-t-
sured against that Osuir. if no pro-
4. Other insurance t off of *othar InsuranoW d'efands,
It valid and collectible'other Insurance'Is we will undertake to do so,but we wiM
available to the Insured for a loss we 158 eMN6d to the Insureds rights
cover under Coverages A or 8 of this against all time pr&Als s of •othar
Coverage Part.our obligations are limited Insurance'.
as follows: When this insurance Is excess over
a. Primary Insurance "other Insurance', wee wIll pay only
our share of the amount of the loss,If
This Imuranou Is primary except any,Ihat exceeds the sum of
when b. below applies. I this Insur- (1) The total anrount that an such
once is primary, our obligations are "other Insurance^"' would pay for
not affected unless any of the 'other
Insurance" Is also primary. Then, we surance;and
km In the encs of this In-
Insurance"
share with all that "other Inuur- ur
endo" by the method described In e. (2} The tool of aldeductible and
below. setfattsurod amounts under that
b. !"±xcoss Irmuranc e " thar lrlsura(M"'
This Inaurta r tMe is excess war army of We wllll &here the raroalnln0 kms, It
the " r IrtsurartW. whothor ptl- any.with any-ww lowuranoo.that is
mart', exons, contingent or on any not described M this t xoass insur-
other bean: once provision.
(1) That Is a Method Of Sharing Fire, Extended Coverage, If an d tlw "other "
Sunders Risk, Installation RisR, b t permits
or skMar coverage for 'your on by we YAII
wow; follow this mothod also. Under this
(2) That Is Fire insurance forap each, provider d Insurance
Ises to you or temporarily contributes equal amounts untl It
has
occupied by you with perrnisslonr lid ft applicable limit of Insurance
or no of re rya, which.
of the owner, over comes first.
(3) That In Insurance purchased by If any of the •other lnsumnce" does
you to cover your Lability as a not
torant for "property e• to ernil contribution by equal
Undesharer
l
r
promises rented to you or tempo- t tare Mill dtautew a hur
Idndeisle method,the of each
rarlly occupied by you with per- provider of Insurance is based on the
mission of the owner,or redo of its
(4) If the loss arises out of the main- ante to the applicable imlt of b�sur-
tenance or use of aircraft, applicable emits of
'autos'. or weUrcreft to theex- rer'oe Of all providers of (nSW-
tent not subject to Exclusion g.of B. The fottlo�Ong dellnhion is added to DEFINITIONS
Section 1--Coverage A—Bodily (Section
tn) Arid Property Damage Ll-
ability; •Other knuraroe":
(6) That Is available to the insured >+ Mems insurance, or the funding of losses,
when the Insured is an addlOonal that Is provided by,through or on behalf oF:
Page 4 d 6 Copyright.The Travelers Indemnity Company,2004 CG 03 96 07 04
COMMERCIAL GENERAL LIABILITY
(1) Another Insurance exxnpsny; 2. Notice of an boaarerx or of an offense
(2) Ua or any of our&Mated Insurance com- which may result in a claim w1t be deemed to
panne, except when the Non cunnfiation be given as soon as practicade to us if It is
of Each Occurrence Urnit sedlon of gNvn In good falth as soon as practicable to
Paragraph 6 of LIMITS OF INSURANCE your work,eW compensation insurer. This up_
(Section 111)or the Non cumulation of Per. piles only if you suiasadiuentty hive notice of
conal and Advertising Injury limit sections the womirreoW or offen5o to us as soon as
of Paragraph 4 of LIMITS OF INSUR practicable after you, ane or your 'executive
ANCE(Seaton 111)apples,. officers"(if you aro a corporation),one of your
(3) Any rtek retention group,• Pins who is an Individual (b you are a
Any *elf-insurance method or
partnership).one company),
), or
(if ere
(4) A
pin. a limited liability y), an'arn "
other than any funded by you end over (such " an insurance, loss control or risk
which this Coverage Part applies;or manager ora nistratcr)designated by you
Any to o such no discovers that the "
(5) ffm simne transfer+x risk menage- rence"or o fonse may Involve this poNcy.
b. Does not include umbmla Insurance, or ex- This Provision K.does not apply as respects
cess Insurance,that you bought specificatiy to the specifiic number of days within which you
apply In excess of the Lhnits of Insurance are reorad to notify us In writing of the
shown on the Declarations of this Coverage abrupt commencement of a discharge, re-
Part. kme or escape of 'pollutants" that causes
J. INCRWED SUPPLEMENTARY PAYMENTS 'bodily lydury" or "p"rhr damage vrhich
may otherwise be covered under this policy.
Paragraphs 1,b, and ML of SUPPLEMENTARY L UNINTENTIONAL OMAN
PAYMENTS—COVERAGES A AND B(Section I The fotlowi 18 added b COMMERCIAL GEN-
-Coverages)are amended as follows: ng
1. In paragraph 1.b..the amount we will pay for ERAL LIABILITY CONDITIONS (Section IV).
the cost of bail bonds Is Increased to$25M. paragrapti 5.(Representa ).
2. In paragraph 1.d., the at we willfor
The unintentional ornission of, or unintenftW
Ws of earnings Is Increased M~� d day. error In. any tnfocmatton provided by you which
we idled uporiw In losuhV this policy shall not
K. KNOWLED" AND NOTICE OF OCCUR- prejudice your rights under this Ineurance. how6
RENCE OR OFFENSE ever, this Pmvirslon L does not aftd our right to
1. The folkywing is added to COMMERCIAL caaa loci ad0brial premium or to exercise our dW
GENERAL LIABILITY CONDITIONS (Section of cancellation or nonrenewal In scoordance with
IV), paragraph 2.(Duties In The Event of Odr applicable,stale Insurance laws, codes or regula-
currence.Offense,Claim or Sult): tkxm.
Notice of an "occurrence"' or of an offense M. PERSONAL ItV URY — ASSUMED BY CON•
which may result in a dalm must be given as TRACT
soon as practicable after knowledge of the 1. The following Is added to Exclusion e. (1) of
""o urrence"or offense has been reported to Paragraph 2., Exclusions of Coverage a.
you, one of your owtecutive offlsoers" (if you Personal Injury, AAvertising Injury, and
aro a corporation), one of your partners who Web 81ts Ir>Jury LlabllUy of the Web XTEND
Is an Individual(if you are a partnership), one Liability endorsement:
of your managers (If you are a Irniltesd lability Sol for the
company), or an "employes" (such as an in- an ly p eat tiebinality In
surance, bas control or risk manager or ad- kwured "". reasonable la
miMstretor) designated by you to give such class and rr for a a ytotheon expenses in-
nagoe. curred�or for a party crlhsr an trwymd
am doomed to be darnages bemuse of"per-
Knowledge by any other "employee" of an tonal InW provided-
Moccurrence' or offense does not Imply that (a) Liability to such party for. or for the cost
you also have such knowledge. of,that parts defense has also been as-
CO D318 07 04 Copyright,The Travelers Indemnity Company,20x1 Page 6 of 6
COMMERCIAL.GENERAL LIABILITY
sumed In the same "Insured c oftscr; N. BLANKET ADDIfiIONAL. INSURED — LESSOR
and OF LEASED EQUIPMENT
(b) such attorney teas and Litigation star WHO:IS AN INSU (Section II)Is amended to
penses ors for defense of that party Include as an Insured any parson or organization
against a civil or alta data dispute (reforred to below as "additions lnsur ) with
lution proceading In WWW domago s to whorn you have*Wood In a WfftA MOW Ox e-
which this Insurance applies we abed. cuted Ware ft lmdfly IrJury"or"properly dam-
2. Paragraph 2.d. of SUPPLEMENYARY PAY- ago" occurs or tho *personal Injury"or"adverds-
MENTS—COVERAGES A AND 8(Section i bVIppy' offense Is committed. to name an
—Coverages)le deleted and replaced by the addliilwat Irssured,but only with resped to their Ii-
tollo itsdx ability for"bodily lr uryO, "property damage,"per--
caused, In
d. T11* alba ns In the "uV and the in- sonai li+�r In
or advertiarog drum"
ra part, by your cads or emissions Irl the
formation wa know about the "occur- rnaintenanco, opembort or use of egs<alpMsnt
rens"or offense me,ouch that no conflict Wood to you by such additional Insured, subject
appears to vadat between the interests of to the mtowlng Provisions:
the Insured and the interests of the Irl- 1. Limits of insurance. The limits of Insurance
dwruaitee. afforded to the additional M1aiu'ed shall be the
3. The third sen of Paragraph 2 of SUIP- IkTa which you agreed to provide in the writ.
PL.EMEI ITARY PAYMENTS— COVERAGES ton eontmcaf.or the limits shaven an the Dedra-
A AND B (Section I—Coverages)Is deletod rat{*,whictver are less.
and replaced by the following. 2. The Insurance afforded to the addlttonal In.
Notwithstanding the p Ions of Paragraph, sumd d not apply"to arty"bodlty lJury""or
2'.b.(2) of Section I— Coverage A—Bodly Irv- "propetty damap" occurs, or opersonal
Jury And Property Damage Uabllity, or me Ijury,or-advertising Ir;u'ryt""`caused by an of-
provisions of Paragraph Ze.(1) of Section 1— fensse which Is ad.after equipment
Coverage B-�Personal Injury,
Advertising In lease expires.
jury And Web Site IrJM Liability, such lay. 3. The Insurance afforded to the additional ln-
ments Wit not be de to be da for tivad is excess war any vatid and ocllae t e
"bodily Iriu'ry" and "prop" go", or "other Insurance!available to such additional
damages for*personal Injury*, and will not re- Insured, unless you have agreed In wrtt-
duce the limits of insurance. ten contract that thio Insurance trust be *
4. This provision M. does not apply If COWSIP rnary to,or n Ibutory with, such *other
for "personal Injury" liability is excluded by Insure.
and'ors smarm,
Page 6 of 6 Copyright.The Travelers Indemnity Comp".2004 CG D316 OT 04
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: DT22-CC-7200PS36-TCT-17 ISSUE DATE: 03/0112017
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED J Th y
GENERAL AGGREGATE LIMIT
Thks endomerrAnt modules Insuran(o praa►Ided under the falwwing:
COMMERCAAL GENERAL L IABIUTY COVERAGE PART
aCHEIDULF;
Dualgruded Pn4act
Deslgnsted Prgect(s): General Aggregate(s):
CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS, JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB#2017-01.
350 MAIN STREET,EL SEGUNDO,CA 80245
A. For all sums Mich the Insured becomes, legally 2_ Any paymerits made under COVERAGE A.
obligated to pay as domes caused by "occur. for damages or under COVERAGE C. for
rencee" under COVERAGE A, (SECTION 4, and medical expenses shell reduce the Desig-
for all medical expenses caused by acootdonts un- nated Prgert General Aggregate Umit four
dor COVERAGE C (SECTION Q. wNch can be that designated 'project", Such pay ants
attributed only to operntioae at a single desW shall not reduce the General Aggregate Limit
noted'project+'shown In the Schedule above: shown In the Declarations nor dealt they
1. A separate Designated Project General Aq- duce any other Designated "ed Geneml
gregate Limit applies to each designated"pro. Aggregate Umtt for any rather desigrmted
Jett", and that limit is equal to the amount of *projecr shown In the Schedule above,
the General Aggregate t.irnk ahown In the w{. The Emits shown In the Declaralons for Each
Declarations, unless ,separate Dosignat9d 001Ourreneoa, Damage To Premises Rented
Project General Aggregate(s) are sched- To You and Medical Expense ceritinue to
ulod above, apply, Howavor, instead of being subject to
2 The Designated Project General Aggregate the General Almeoste L in the
Limit Is the most we will pay for Elis sum of all DedertlkM Such limits Wil be Irautiect to the
dernages under COVERAGE A, excerpt applicable t aalgnatad ProjW Goneml
damages because of"bodily hJuty°" or"prop- gregate LWL
arty damage" Included in the 'products- B. For all surns which the Insured becomes legally
completed 9"raftne twzard•. and for medi- +r bli0atod to pay as darnmg= caused by `ecmr-
cal expenses under COVERAGE C. regard- rendes`under COVERAGE A (SECTION 0,and
leas of the number of for all med1cal expenses caused by accidents un.
a. Mirada; ewer COVERAGE C. (SECTION p, which catirtot
Ere attributed only to operations at a<aingle desig-
b. Claims made or"suits"txewght;or nated"prejecr shown In the Schedule above:
a Parcone or orpnizations mawng claims
or bringing"arts".
CC 021 t 0104 CopyriOt.The Travelers Indemnity Cmpany,20x4 Page 1 of 2
COMMERCIAL GENERAL LIABILITY
1. Any payments made under COVERAGE A. vided, any payments for damages because of
for damages or under COVERAGE C. for "bodily Injury" or "property damage" included In
medical expenses shall reduce the amount the "products-completed operations hazard' will
available under the General Aggregate Urnit reduce the Products-Completed Operations Ag-
or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggw
gregate Umlt.whichever Is applicable;and gate Limit nor the Designated Project General
2. Such payments shall not reduce any Desig- Aggregate Umit
nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini.
C. Part 2.of SECTION III—LIMI M OF INSURANCE tions Section Is amended by the addition of the
Is deleted and replaced by the following: following definition:
2. The General Aggregate Limit Is the most we "'Project" means an area away from prmlses
will pay for the sum of: owned by or rented to you at which you aro per.
a. Damages under Coverage B;end ming operations pursuant to a contract or
agreement. For the purposes of determining the
b. Damages from "occurrences" under applicable aggregate Ilmft of Insurance, each
COVERAGE A (SECTION l) and for all "project" that Includes premises Involving the
medical expenses caused by accidents some or connecting lots.or premises whose cora-
under COVERAGE C (SECTION 1)which neadfon Is Interrupted only by a street, roadway,
cannot be attributed only to operations at waterway or right of-way of a railroad shall be
a single designated"project shown In the considered s single"project•.
SCHEDULE above. F. The provisions of SECTION III — LIMITS OF
D. When coverage for Ifabtifty arising out of the INSURANCE not otherwise modified by this en.
"products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated.
Page 2 of 2 Copyright,The Travelers Indemnity Company,2004 CO 02110104
Unwed: (*C-ongmdlofi.inc..Slept"Dore"E•qutpmm t Rerrtete,Ift COd144E1ttOAl.AVFC?
"c* 'OT-810-OD467697-TIL-17
TNIS ENDORSEMENT rCHANOM THEPOLICY'*PLEASE READ IT"REFULM
AUTO COVERAGE PLUS CITY'OF EL'3 c' k $ FICERS,OFFICIALS,
EMPLOYEES,AGENTS AND VOLUNTEERS
350 MAIN STREET,EL SEGUNDO,CA 80245
TNp a+dara6rnartt � proNidid Ul1dAf tltb atOtt+3' .
AMCOVERME FORM JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
1 D 50E 9 1111,
Wer to P, ,Wo by tHs and td} ��a�r �1 � � �tattt�
matnt the VwWms of ft Ooymo Fowl0ply Insurance, tth. AoMeot or Disability
unless modilled by dw dtrldomertrarat. Inst pvmloon or
A. 11IFFI1 COV E 10086;and
SEMN M w PWISICAL DAMAGE COYM y- r ba Imm pew"'loans
ACEI„,,A. e,4, raga ns)Ona is
DE — AVDIM 1113111U.
s.
pa�oa l E ri
to Crimp AND
AND TA ELE TRO EQ(APMEW NOT
uvea air tri 400 for*WV to Wrog ep- OF SOUND
SOLELY Ip�aN THSl�'t�ttTllt�l�l
parel wW o0w personal ofteats whk-.h arra- EE:t:Y'M 10 — Pt YOMAL DAMAi= COM-
(1) ownW by an Irwi c ,and • O. tr 1 1ar*. omption panVmph 4k. ^fir
M k 1 army=c vered'ra aYt exeWIMIt+« a&4A W doWed SM MPIGM WIM
In ft ovw*of a 1W*oft Nash"'Of Y=c ww" Jim t'altninT.
oautdo. a. Equknwd wd aomestorks USW with atratr
No deductIbles apply to al t) oft Gwftt- eviw^ aexcepi s or discs.
art such oqui t Is p0maretilty h.
of the
& AUTO LOAN LEASE GAP CtiyVERAti@ d Ira the t ararad'laautcr attlrtrs
" or to turnwabla frr m as housing unit
RECTION M -- PWGICAL DAMAGE COVER-' Is paffrw&rrfty ktstallod In the ooverad
AGF,A. 4Ceverage,4.c go Extwelow is "eat" at ttw tkne of 1114 "Ions,. anxi such
amended by adding tt't0 foflowkKF "Apment Is desicined to be solely r petated
Auto Loon Le t3aap gi far of the the" » rr electt-
'Paeaartger' ir"te+t''�",ehkloer caaast'anter►"r.IT upon Me cavereId"aar�tr�car
In ftovert d a Ental Ion"to a wyervd"wAt+'of � � R OF DEl]U CiIBI.E GLASS
'vw pdv&%pearsengartAw sholm In the Sd dulo SE N' Itt ICAL DAMAGE COVEP-
or
for w ob Physical Damage - AQF,P. Dodue is a=mled by a3dIN the
erage Is pvAftd.we will pay may unpaid arrount rouawkw.
due on the lom or turn for such coverod'ate. Ko> doduclible for a covored *aute vAl ap* to
ieatat ala ttolld nW- s damalre If the glass Is repaired rafts than
M Tbo anmnt paid under the"ioai Damage wp4awd.
Covarago Section of#em Policy for ftud"OUW. E, "MED AUTO PHYSMAL DAWAGE Ci?itEW
and AGE
(2) ArV. SECnON III -- PHYSICAL DAMAGE Cho 4
(o) Overdue e I Mmlynft of N*Um AGE,,, A. Covarago, +4. Coverego Wonslons to
of the'tow; arnondod by eMirg the
(b) Firrrtndat penattles krpos*d twidor e Hired Auto Phystaaal OExbn-
l+ea a for ex Ivo use. obnomwi a+wew story
and t+eup at tAg1>,t ilia i It hired llautosll am covered w W for Llatrlilty
(c) Sew*depoetts not re1>rned by fAe'bw Comrago sod thlo p o y also pmmvidea Phyoloal
oar, Damage Cmemco For arra 0mled oattrw, n
CA T4 201V OG pyotQhW4 matarlar of IMMr40 SONIOM 0014%shwa,VAZ PA POnVIVeM. Page i df 2
Icy of Ttwa ft PwA TrA CaNm Inc.
COMMERCIAL AUTO
Physical Damage Coverage la extended to lent MWred of you by a wMan conked exe.
'eutoa'that you hire,rent or borrow subject to the cuftd prior to any 'a ent" oor' 1W, pro-
following: vided that the%ccldete or "anise's out of
(1) The most we wW pay for'bas"in any one M operations corftmplated by
such con-
*a=Werr to a hired, rented or borrowed trea organization designated applies In only to
the tapers or
la' such
soIs the lesser of:
(a) SWAM. G. BLANM AD NAL INSURED
(b) The actual cash value of the dam- S ON N—LIABIUTY COVERAGF,pan A.1.
aped or*Iden property as of the time Who Is An Ins d,paragraph c.Is amended by
of the IoW;or adding ttra
(c) The oast of repalrtrts or replacing the Any Wsm or b an cul o orate Cover,
damaged or sWen property with
other property of Ike kind and qualty. ape Form In a wrttlsn contract or agreement tinct
Is signed and executed by your bafbre the'bodily
(2) An adjustment for depreciation and lnjury"ear Ixoperty damage occurs and that Is In
physical oondltion WM be made In deter- ~during the policy period R an "for
rnWng actual Cash value In the event of a Liability Coverage,Iwai Only for damages to wNch
total's. two Insurance es only to the Went thwat
(3) N a repair or aowmt Bement reaulm In better person or orgarftation quaAMs as an "Insured"
than Ike kW or quality, vm wAl not pay under the Who Is An Ironed provision contained
for ttwe amount of be tshvent In Sectlon IL
(4) A deductible equal to the Nghest Physical K EMPLOYEE WRED AUTOS
Damage deductible eppilcable to any SECTION R—LIABILITY COVERAGE.A.Cow
omied covered . arage,I-Who Is An Insured Is emended by add-
(5) This Coverage Extenslon does not apply Ing the fallowing:
to: Are .of Y=0 Is an "while op-
(a) Any'atW that Is hired,rented or bor- erallnu an hired or rarted under a omtract
rowed with a driver;or 'or agreement In VW 'employee's" name. with
(b) Any•auto'that Is Nred.rented or bor- your pormlodudes related
rowed from your'r mpl '« bushes*.
F. BLANKET WAVER OF SUBROGATION L COVERAGE EX I NSION—TRAILERS
SECTION IV—BUSINESS AUTO CONDITIONS, SECTION I — COVERED AUTO& C. Cerlsln
A. Loss Conditions. L Transfer Of Right* Of Trallom Mobile Equipimnli and Temporary
Recovery Againat Others To Us Is deleted and Su1tg 1. Is deleted and
replacedby the following: replaced by
b. Transfer,Of Rights Of Recovery Against 1. "Tr^a%W with a load capacity of 3,
Othom To,Us pounds or less designed rely for tnwvel
We valve any rW of on purbilc roads..
against any person or organIzadon to the ex.
Page 2 of 2 I n*0fts M o odgt ted mNWW of Wursw*SwvW"01ft r Aas.%%td paminkrc CA T4 2Q 07 Oct
Includes ttwa=Wft ad rnWgdr d TM et.Paul Trawler ODnrp.riw,hv.
Tial veimrx �"C�** 'WORKERS COMPENSATION
AND
EMPLOYERS UABUJTY POLICY
ENDMIEEMENT WC"03 76(00) —
POLICYINIUMBER: DTJ-UB-720OP538-17
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
Wo haivo the tight to recover our payments from anyone gable for an Injury covered by this Polley. Wo win not
entorco out tiaht age trist the per on or organization named in then Schedule.
You must maintain payroll records socureWly 9MV69allra the rMun6ftflish Of your employee$wwle en g"In
the Work described in the Schedule.
The additioml premium for tilds andat"nwAt shall be %of the California warkers'compeneMlon pw
mium otherwise due on such remuneration.
BGhedule
Person or Organt"Von -fob Dsser*fth
CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS, JOS: WATER MAIN 1WROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB 0 2017-01.
360 MAIN STREET,EL SEGUNDO,CA 90248
DATEOFISME: awou2m qTA3.siGK-